Provider Demographics
NPI:1578659603
Name:DRUIAN, PETER R (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:DRUIAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E KING ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3004
Mailing Address - Country:US
Mailing Address - Phone:610-889-2295
Mailing Address - Fax:610-647-8921
Practice Address - Street 1:412 E KING ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3004
Practice Address - Country:US
Practice Address - Phone:610-889-2295
Practice Address - Fax:610-647-8921
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005016L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
085931OtherBCBS
PA085931Medicare ID - Type Unspecified